Contents

▲ 1. Abstract

Biological investigations report that there are several disease processes involving factors of environmental pollution. Pollution has direct effects on lungs, causes lung diseases and indirect effects on all parts of the body. Here, an attempt has been made to study the effects of pollution on hepatitis, the inflammation of liver. Nitric oxide is suggested to play a primary role in vasodilatation. The diagnostic methods of choice for diagnosing the disease are enzymes and antibody detection tests including ALT test, ALP test, Bilirubin test, PCR test, etc. It is a progressive disease with poor outcomes. No effective medical treatment exists and vaccination is the treatment of choice.

Keeping in view, the above said discrepancy attempt has been made in this study to co-relate the Environmental Pollution with Hepatitis, so that the control of Environmental Pollution may help in reducing the intensity of the above mentioned disease.

For that purpose, the data of hepatitis patients was collected in specially selected hospitals and analyzed for the determination of the environmental hepatitis. For the confirmation of these experimental findings, a sociological survey was conducted accordingly. 100 people were selected for that purpose. Questionnaires were distributed among them, and collected back after the prescribed limit of time. The data provided by them was analyzed statistically and co-relation was found positive.

A detailed study of hepatitis and the people living near the environmentally polluted areas with respect to air, water, land, marine and industrial pollution revealed that hepatitis viruses infected most of the people.

▲ 2. Introduction

God has made this universe and we, as a creature for some purpose and set a balance and symmetry in every thing. All the things around us such as plants, water, air, animals, etc. makes our environment.

The relationship between human and his environment is a two way process. If one disturbs, other will be automatically the victim. Therefore, the present work has been taken to illustrate the impact of ill environmental health on the health of human beings in respect of hepatitis.

The environment provides man with the essential life support systems, which comprises air, water and land, but it also presents him a variety of hazards, which may prejudice his health.

▲ 2.1 Health

The World Health Organization recognizes that Health is the fundamental right of every man without distinction of race, religion, political belief, economic and social conditions. While every effort is being made in attaining this conception, much remains to be done.

The WHO has defined “Health” as a “State of Physical, Mental and Social well-being and not merely the absence of disease and infirmity”. It represents a balanced relationship of the body and mind and complete adjustment to the total environment.

Health signifies a soundness of body and mind but we are confronted with the difficulty of determining its relationship to disease. Health and disease must be intimately related for if disease did not exist it would be irrelevant to talk of health.

▲ 2.2 Disease

Disease may be called as an abnormal state of body resulting from harmful effects of processes, injurious substances or accidents. In general, “disease is a state of body in which certain natural functions are so disturbed that the individual cannot meet the usual requirements of life”. On the other hand, “disease is maladjustment or maladaptation in an environment, a reaction for the worse between man and hazards or adverse influences in his external environment.” The response of the individual to these influences is conditioned by his genetic make-up or internal environment.

Environmental pollution may be described as the unfavorable alteration of our surroundings attributed to the anthropogenic activities of man. Environmental pollution takes place through changes in energy patterns, radiation levels, chemical and physical constitution and abundance of microorganisms. Pollution included release of materials into the atmosphere, which make the air unsuitable for breathing, harm the quality of water and soil, and give out substances which damage the health of human beings, plants and animals. Though the other environmental pollutants, odour and noise only disturb the cell function, they can also some times be a danger to health. The effects of pollution to our biosphere are numerous and are increasing alarmingly.

The pathway of impact of the environment in the human body evidently are the systems that are exposed to hazardous materials, covering the external skin and the internal respiratory and alimentary systems, each with an array of organs and functions, and with an ultimate bearing on the structures and organs of the body as a whole.

It was not until the middle of the 19^th century that man’s understanding of nature grew that he could bring the major environmental health hazards to his control. Another half-century later achievements of sanitary engineering and preventive medicine in adapting the environment to man were complemented by the success of therapeutic medicine in helping man to conquer some of the diseases.

It is interesting to note that health has direct relation to environment. Several diseases have a direct relation to environmental management. The environmental components involved in communicable diseases such as malaria, schistosomiasis, filariasis and trypanosomiasis. Also many other ailments like asthma and allergy are known to be environment linked. The efforts to control these diseases through environmental interventions directed at the habitats of their vector have come in for considerable attention. But the large scale use particularly in developing countries, of growth promoting substances to increase concern about chronic toxic effects in human beings, which might ultimately be related to cancer with incidence affecting the skin, mouth, lungs, liver, kidney, breast, vascular systems, etc. Among these growth-promoting substances are antibiotics, hormones and vitamins.

▲ 2.3 Cancer

The relationship between cancer in different parts of the body and various environmental contaminant and pollutants, have been increasingly observed over a long period. Keeping in view this effect of cancer, a study was conducted at Allied Hospital, Faisalabad, related to different kinds of cancer and was found correct.

(Ref: Mini Project titled “Effects of Environmental Pollution on cancer ”, written by “Teyaba Kanwal” under supervision of “Prof. M. Attiq Khan Shahid”)

Table 2.1   Viruses Associated with Human Cancers

Viruses	Types of Cancers
Hepatitis B Virus (HBV)	Hepatocellular carcinoma
Human Papillomaviruses (HPV)	Cervical and other anogenital carcinomas
Squamous cell skin carcinomas
Epstein-Barr virus (EBV)	Burkitt’s and other B-cell lymphomas
Nasopharyngeal carcinomas
Human T-cell lymphotropic Viruses (HTLV-1)	Adult T-cell leukemia
Human immunodeficiency Virus (HIV)	Lymphomas, Kaposi’s sarcoma, anogenital carcinomas

Hepatitis B virus causes Hepatocellular carcinoma, a type of cancer. So that it is observed that Hepatitis and cancer correlate to each other.
It is now generally agreed that between 60 and 90 percent of all cancers are directly or indirectly related to the environment, that is, related to factors, in water, air, solar radiation, living and working environments and personal choices of diet and ways of life such as tobacco smoking and alcohol consumption. The assumption is that all cancers are environmentally caused until it can be proved otherwise.

Viewing the world as a whole, the net effects of many known cancer-causing factors remain substantial, though none is as prominent as tobacco. The Table 2.2 given enlists causes of cancer.

Table 2.2   Environmental Factors that Cause Cancer

Factors	Percentage of all cancer death
	Best estimate	Range of acceptable estimate
Tobacco	30	25 – 40
Alcohol	03	02 – 04
Diet	35	10 – 70
Food additives	< 1	-5 – 2
Reproductive and sexual behavior	7	01 – 13
Occupation	4	02 – 08
Pollution	2	< 1 – 5
Industrial products	< 1	< 1 – 2
Medicines and medical procedures	1	0.5 – 3
Geophysical factors	3	02 – 04
Infection	10 – ?	1 – ?

▲ 2.4 Hepatitis

Hepatitis is a general term used to describe inflammation of the liver. This means that there are too many inflammatory chemicals being produced and released in the liver, which damages the liver cells.

Hepatitis commonly results from a virus, particularly one of the five hepatitis viruses — A, B, C, D, or E (a sixth category called hepatitis virus G had been created but has since been retracted). Less commonly, hepatitis can be caused by excessive alcohol, toxic chemicals, incorrect diet, some drugs such as paracetamol, autoimmune diseases, poisons, non-viral infections like Q fever, and various viral infections including glandular fever as well as some diseases of the biliary system.

Hepatitis can be acute (short-lived) or chronic (lasting at least 6 months). It is common throughout the world.

▲ 2.4.1 Hepatitis A

Hepatitis A virus (HAV) is an RNA virus. The virus is present in blood and bowel movements for two to three weeks before any symptoms develop and for two to three weeks afterward. During this time, the hepatitis A virus can infect anyone who handles anything contaminated by blood or feces.

Hepatitis A is the commonest type of viral hepatitis and occurs worldwide. Hepatitis A is also known as infectious hepatitis. The virus attacks the liver producing an acute illness. This illness usually lasts for several weeks and resolves quickly once the virus is cleared from the body. Occasionally the illness recurs within three months after the initial episode. Those who have been infected develop antibodies that protect against further episodes of hepatitis A. In those who are run down to start with there may be a prolonged or relapsing illness and this occurs in around 15% of cases. However unlike hepatitis B or C, a chronic illness does not develop from the hepatitis A virus, and once the virus is cleared from the body a permanent immunity is acquired. Hepatitis A virus does not cause a carrier state or chronic hepatitis.

▲ 2.4.2 Hepatitis B

Hepatitis B is a deadly liver disease caused by virus B. Hepatitis B virus (HBV) is a DNA virus, which is an important cause of acute and chronic liver disease worldwide with the highest incidence rates in Far East (15%) and the Mediterranean (5%). It can lead to long-term liver complications like cirrhosis, cancer and ultimately death. Globally, Hepatitis B causes about two million deaths every year and there are 350 million carriers of the virus. It is responsible for 80% cases of liver cancer. Viral Hepatitis kills more people than cancer or any other infectious disease.

It is 100 times more dangerous than AIDS. In Pakistan every 10^th person is carrying Hepatitis B virus without any symptom and can transmit this disease to other persons.

Hepatitis B is highly contagious during the four to six weeks before symptoms appear and for a variable period afterwards. Type B hepatitis is often more severe than type A and has a longer incubation time. The incubation period is 2 – 4 months.

The Hepatitis B surface antigen appears early in the course of the disease and may persist for several months. If this surface antigen remains positive after 6 months from the onset of disease, it will likely persist indefinitely and the individual will become a chronic carrier of Hepatitis B. Up to 10% of patients with acute Hepatitis B will develop chronic hepatitis, which can result in cirrhosis (scarring of the liver) or liver cancer. It is the ninth major cause of death.

Hepatitis B virus can survive outside the body for long periods of time. There are approximately 300 million new infections of Hepatitis B per year in the world.

▲ 2.4.3 Hepatitis C

Hepatitis C is caused by a collection of viruses that belong to neither the type A nor type B disease. Hepatitis C virus (HCV) is an RNA virus, which was responsible for 90% of post transfusion hepatitis until screening of donor blood was introduced. This virus, which is sometimes difficult to identify, causes most of the hepatitis spread through blood transfusions. Previously it was known as non-A, non-B hepatitis till it identified. Hepatitis C often has a more prolonged course than A and B.

Hepatitis C virus (HCV) is classed as the fastest-growing infectious disease in Australia and America, and this upward trend is set to continue through out the world. If it does, by the year 2010 we can expect many thousands of people to have developed HCV- related cirrhosis, with many requiring liver transplants. It is an epidemic problem. Infection with the hepatitis C virus is common, and there are around 300 million people worldwide who have contracted this virus.

Researchers estimate that in Australia, 1% to 3% of the general population tests positive to hepatitis C virus. In the USA the incidence is estimated to be around 2.8% of the population, while in many parts of Asia infection rates are much higher than this. HCV was only identified in 1988. It is 10 times more infectious than HIV, and unpublished research in Victoria suggests it may survive for long periods on needles and other equipment. In the 1980’s, AIDS was the major public health challenge for community-based doctors. Now Hepatitis C has this dubious honor.

People are generally completely unaware that they have contracted this virus because it does not produce any symptoms in the early or acute stages of the infection. During the first 3 to 6 months after infection, the virus replicates itself rapidly and the immune system tries to fight it by producing antibodies against it. Unfortunately in 80 to 85 percent of infected people, the virus is not eliminated and becomes a long-term inhabitant of the body. In other words, the infection becomes chronic. In a significant percentage of people with chronic infection, there are no signs or symptoms of disease and many are unaware that they are carrying an infection that can be transmitted to others through contact with their blood.

▲ 2.4.4 Hepatitis D

Hepatitis D occurs in the context of Hepatitis B and still is uncommon in the world.
Hepatitis delta virus (HDV) is a defective RNA virus, which depends on hepatitis delta virus replication. It occurs as a co-infection with Hepatitis B virus or as a super infection causing an acute exacerbation of chronic Hepatitis B virus infection. Cirrhosis develops in 50 -70% of those who develop chronic HDV.
Hepatitis D occurs most often among people who share needles to inject illicit drugs.

Symptoms are mostly same as that of Hepatitis B but when a person with Hepatitis B has Hepatitis D as well, symptoms are more severe.
Vaccination against hepatitis B virus eliminates the risk of hepatitis D virus as well. Hepatitis B immune globulin also protects against hepatitis D infection.

▲ 2.4.5 Hepatitis E

Hepatitis E, enterically transmitted virus, yet has not been found common in the world.
Hepatitis E is spread primarily from the stool of one person to the mouth of another. It causes occasional epidemics, which are often waterborne, similar to those caused by hepatitis A virus. So far, these epidemics have occurred only in underdeveloped countries.

Hepatitis E may produce severe symptoms of acute viral hepatitis, especially in pregnant women. Chronic hepatitis or a chronic carrier state does not occur.
No vaccine is currently available. The usefulness of standard immune globulin is not known.

Ongoing research should lead to a clearer understanding of the natural history and epidemiology of Hepatitis D and Hepatitis E.

▲ 2.5 Environmental Pollution

Pollution may be defined as the introduction by man in to the environment of substances or energy liable to cause hazards to human health, harm to living resources and ecological systems, damage to structure or amenity, or interference with legitimate use of the environment.

▲ 2.5.1 Classification of Pollutants

Pollutants have various alternative systems for their classification. Mainly pollutants are classified on the basis of their:

• Nature
• Chemical composition
• Physical State
• Properties
• Sectors of Environment
• Patterns of Use as:
  • Use in industry as solvent
  • In agriculture as fertilizer
  • Pesticides, in transport as lubricant and in defense as well

In this research report, we discuss the pollution classification by environmental sector only, because this research is only linked to environmental pollution.

▲ 2.5.2 Pollutant Classification by Sector of Environment

Environmentally, we can classify the pollutants in the following categories.

▲ 2.5.3 Effects of Environmental Pollutants on Human Health

In Environmental Pollution we are concerned wit the poisons that occur in the ambient environment to which human beings may be exposed. This involves exposures to the pollutants in the workplace and food chain as well as natural and man-made activities.

▲ 2.5.4 Routs to Exposure of Pollutants

There are three major routs to exposure of hazardous materials which includes:

• Ingestion
• Inhalation
• Dermal Absorption

▲ 2.5.5 Body Response to Pollutants

The response of the body to pollutants is to attempt to:

• Render them harmless
• Less poisonous and more soluble
• Excrete

These are done by metabolism and the principal site for this detoxification is the liver.

In case when dose of certain pollutants becomes too large to be detoxified, these act as systematic poisons and target various organs. Some examples of systematic poisons and their target areas are indicated in table 2.3.

Table 2.3   Systematic Poisons and Target Organs

Systematic Poisons	Target Organs	Examples
Heaptotoxic agents	Liver	· Carbon tetrachloride · Tetrachloroethane
Nephrotoxic agents	Kidneys	· Halogenated · Hydrocarbons
Haematopoietic toxic agents	Blood	· Aniline · Toluene · Nitrobenzene · Benzene · Phenols
Neurotoxic agents	Nerve system	· Methanol · Carbon disulphide · Metals · Organomettalics
Anaesthetics/Narcotics	Consciousness	· Acetylene hydrocarbons · Olefin · Ethyl ether, Isopropyl ether · Paraffin hydrocarbons · Aliphatic ketones · Aliphatic alcohols · Esters

▲ 2.5.6 Co-Relation Between Liver and Lungs

Recently it was shown that there is a correlation between exhaled NO and alkaline phosphates, AST, ALT, Albumin and Billirubin (enzymes or protein synthesized by liver involves in the prediction of liver diseases e.g. Hepatitis) suggesting induction of NO synthesis by agents normally metabolized in liver.
NO has a primary role in vasodilatation and it is a vasodilator with regulatory action of vascular tone in humans.

In one study it was observed that exhaled NO is increased in decompensated liver cirrhosis, while those with compensated liver cirrhosis, chronic active hepatitis and normal control patients had the same amount of exhaled NO.
It seems that increased NO production is due to induction of NO synthesis within pulmonary endothelial cells by some stimulatory factors secreted by diseased liver or hypertensive portal system.
Cardiac index also correlated with NO level, revealing the role of NO in systemic circulatory disturbance.

More than 80% of patients present with signs and symptoms of liver disease but in about18%, the presenting symptoms and signs are relates to lung disease.
Selenium oxide is another vasodilator and has direct effect on liver and hence caused a liver disease. Selenium basically is a mineral that prevents the liver from diseases but when it reacts with oxygen and forms selenium oxide, it changes it chemical properties and become toxicant for the body organs especially liver.

▲ 2.5.7 Specific Pollutants Effects

There are a wide variety of body responses to environmental pollutants that are of concern in the field of poisonous material management.

▲ 3. Diagnostic Studies (Materials and Methods)

As this report contains two different types of studies. So we have two different types of diagnostic methods. One is for Hepatitis and other for Environmental Pollution.

▲ 3. A Diagnostic Studies For Hepatitis

This section describes a wide variety of options of tests that are available to diagnose the Hepatitis. It does not advocate application of the entire range in all population. In some settings, only some of the options may be relevant and enough to diagnose the disease. In all settings, the goal is to arrest the disease by any means to provide the need of treatment.

Mostly there are used blood tests or LFT’s (including ALT, ALP, billirubin and PCR tests), which are responsible for the prediction of hepatitis. However some other tests are also used to diagnose the disease e.g. antibody tests, CT – scan, liver ultrasound, liver biopsy etc.

▲ 3.1 Blood Tests

Liver Function Tests (LFTs) are used for the ongoing monitoring of hepatitis positive people. There are two aspects to liver function testing. The first is signs of liver injury. When liver cells are damaged or killed the enzymes that exist inside the cell to do work leak out into the blood stream. We can measure this. Because cells are dying and being replaced constantly, there is a little of the enzyme in your blood all the time. The amount present goes up when viral infection, toxic chemicals or alcohol, etc are injuring the liver. These enzymes have a ‘normal range’. It is only when the amount present exceeds the normal range that it clearly indicates ongoing liver damage. To complicate the issue, some people with normal liver enzymes (LFTs) also have ongoing damage. Signs of liver failure can also be observed through blood tests results.

How it is done?
No special preparation is required before having a blood test. Talk to your health professional about any concerns you have regarding the need for the test, its risks, or how it will be done.
The health professional drawing blood, will wrap an elastic band around your upper arm to temporarily stop the flow of blood through the veins of your arm. This makes it easier to put the needle into a vein properly because the veins below the band get larger and do not collapse easily.
The needle site is cleaned with alcohol, and the needle is inserted. More than one needle stick may be needed if the needle does not get placed correctly or if the vein cannot supply enough blood.
When the needle is properly placed in the vein, a collection tube will be attached to the needle and blood will flow into it. Sometimes more than one tube of blood is collected.
When enough blood has been collected, the band around your arm will be removed. A gauze pad or cotton ball is placed over the puncture site as the needle is withdrawn. Pressure is applied to the puncture site for several minutes and then a small bandage is often placed over it.

▲ 3.1.1 ALT (Alanine Aminotransferase) Test

It is a type of blood test. It is the first laboratory sign of Hepatitis B and C infection.
Basically ALT is an enzyme or a type of protein that is synthesized by liver. By blood test we see its quantity present in liver either that is normal or not. Normally ALT presents in human blood in the range of 9 – 40 mg/dl. But if its quantity in blood differs that would be the sign of the presence of the disease. In most cases its quantity leaks from a damaged liver.

▲ 3.1.2 ALP (Alkaline Phosphatase) Test

It is another type of blood test. ALP is another enzyme that indicates the presence of the disease.
ALP is an enzyme or protein synthesized by the liver in large amount when there is obstruction of the bile ducts to the normal flow of bile.
By blood test we measure its amount in laboratory to assess the function of liver. Normally in human blood ALP present in the range of 80 – 300 mg/dl and in case of hepatitis it increases in blood.

▲ 3.1.3 Billirubin Test

Basically billirubin is a chemical breakdown product of hemoglobin (the red blood cells). It is also measured by blood test.
We take some specimen of blood and measure the amount of billirubin in that specimen of blood in the laboratory to assess the liver function and find the presence of the disease.
Normally a human blood contains 1 mg/dl of billirubin, 0.25 mg/dl is present as a direct source and 0.75 mg/dl as an indirect source. In the presence of the disease the amount of billirubin decreases in blood.

▲ 3.1.4 PCR (Polymerase Chain Reaction) Test

PCR is a genetic base test used to amplify the genetic material of the virus to a level that can be detected the disease. PCR tests look for actual virus in the blood. It is useful when antibody and enzyme tests are unclear. This is a DNA like test by which we can predict the presence of hepatitis. It is the viral load that the PCR tests for. It is often required to have these tests done to confirm a diagnosis.
In simple words it is virus detection based test and used to analyze the virus.
PCR testing is technologically difficult and very easily contaminated, so tests should be done on a fresh blood specimen, which has not already been tested. The test amplifies up the tiny amounts of virus, which are present in the blood of an infected person. In the early days, there were major problems with quality of PCR tests and variability between laboratories. It is much more reliable nowadays but as always, no test is 100% fail safe and results need to be looked at in context and with a critical eye. There are three types of PCR.

• Qualitative simply detects if the virus is present
• Quantitative detects how much virus is present
• Genotype detects which kind of hepatitis C virus

▲ 3.1.5 GGT (Gamma-Glutamyl Transpeptidase) Test

It is another type of blood test used to diagnose the disease. GGT is the liver enzyme that has been traditionally used as a marker of excess alcohol intake. If your GGT is up at all, you should consider giving up alcohol altogether whilst you are infected with hepatitis specially hepatitis B and C. People with elevated GGT tend not to respond well to interferon. If GGT is over 100 or so, it can also be associated with gastro-intestinal symptoms (nausea, bloating, appetite disturbance and wind). Some people also have itching of the skin, the result of impairment to bile flow associated with bile duct damage, which is reflected in the elevated GGT. Your doctor can measure your bile acid levels and type on a regular blood specimen. These symptoms may be alleviated by the use of a medication called urso-deoxycholic acid (USDA), which is a ‘friendly’ bile acid and protects your bile ducts from ongoing damage. This medication is available on application to the ‘special access drug scheme’.

▲ 3.1.6 Serum Protein Test

Blood serum contains large amounts of protein. Two major groups of proteins in blood serum are albumin and globulin.
A total serum protein test measures the total amount of protein in blood serum as well as the amounts of albumin and globulin. The amounts of albumin and globulin can help a doctor diagnose certain diseases e.g. hepatitis. In blood serum total range of serum protein is 5.5 – 9 g/dl.

1. Albumin
   Albumin is a main circulating protein in blood stream synthesized by liver. It helps keep the blood from leaking out of blood vessels. When albumin levels drop, fluid may collect in the ankles, lungs or abdomen. Albumin also helps carry some medications and other substances through the blood and is important for tissue growth and healing.
   The range of albumin in blood serum protein is 3.5 – 5.5 g/dl. The decrease of the albumin in blood indicates the presence of the disease.
2. Globulin
   Globulin is made up of different proteins that can be separated into alpha, beta, and gamma types. The liver forms most of the globulins. Certain globulins (haptoglobins) bind with hemoglobin. Other globulins transport metals, such as iron, in the blood and help fight infection.
   The range of globulin in blood serum protein is 2.0 – 3.5 g/dl.

▲ 3.1.7 AST (Aspertate Aminotransferase) Test

AST is another type of blood test to measure the amount of AST in the blood to diagnose the disease.
AST is an enzyme or protein synthesized by liver and decrease in its synthesis predicts the presence of the disease.

▲ 3.2 Antibody Detection Test

It is an initial screening test for Hepatitis tests for the antibodies to the virus so it does not look directly for the virus itself.
An antibody is a protein produced by your body as a defense against the virus. We make antibodies against any organism that gets into our body and we also produce antibodies when we are vaccinated for measles, flu, hepatitis B, polio etc.
Positive antibody test suggests the presence of some form of autoimmune illness.
Sometimes this test comes back intermediate and then a repeat test is required. Antibodies are produced in the body after exposure to the virus and have produced antibodies to fight it.
It does not determine whether or not someone still has the virus or how long he or she has been infected. It takes up to 6 months for antibodies to hepatitis virus to form in the blood. This up take is called as seroconversion. It is therefore important to get retested 6 months after initial antibody test.

▲ 3.3 CT – Scan

A CT (or CAT) scan is the term used to describe a radiologic test known as "computerized tomography" (or computed axial tomography). The CT scanner is a doughnut-shaped machine that uses advanced x-ray technology to take pictures of cross-sections of your body.
CT scan provides anatomic information about liver such as size and shape of the liver.
CT scanners use x-rays. For your safety, the amount of radiation is kept to an absolute minimum and our equipment is kept in top shape.

How it is done?
The CT scanner looks like a large donut with a narrow table in the middle, in which you would be placed inside the tunnel of the scanner. When undergoing a CT, you rarely experience claustrophobia because of the openness of the doughnut shape of the scanner. For CT scan of liver, you lie on your back on the table, which moves through the center of the machine.
You must remain motionless for the length of the study, which is typically just a few minutes. The entire procedure, which includes set-up, the scan itself, checking the pictures, and removing the IV needle if needed, takes 15-45 minutes.
As part of your test, before or during the study, you may be given an injection (by a nurse, technologist or doctor) of a contrast agent. This allows the radiologist to obtain clearer images of the organ.

▲ 3.4 Ultrasound Scanning

Ultrasound scanning or sonography is a method of obtaining images from inside the human body through the use of high-frequency sound waves. The reflected sound wave echoes are recorded and displayed as a real-time visual image. No ionizing radiation (x-ray) is involved in ultrasound imaging.
Ultrasound is a useful way of examining many of the body’s internal organs, including but not limited to the heart, liver, gallbladder, spleen, pancreas, kidneys and bladder. Because ultrasound images are captured in real time, they can show movement of internal tissues and organs and enable physicians to see blood flow and heart valve functions. This can help to diagnose a variety of organ conditions during and after illness.
Just like CT scan it also provides anatomic information about the liver, such as size and shape of the liver. The only difference between the two techniques is the use of ionizing radiation (x-ray). In CT scan x-rays are used but in ultrasound scanning this technique in not involved.

How it is done?
Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to scan the body. The transducer is a small hand-held device about the size of a bar of soap, attached to the scanner by a cord. The physician or technologist spreads a lubricating gel on the patient’s abdomen in the area being examined and then presses the transducer firmly against the skin to obtain images.
The ultrasound image is immediately visible on a nearby screen that looks much like a computer or television monitor. The physician or technologist watches this screen during an examination and captures representative images for storage. Often, the patient is able to see it as well.

In liver ultrasound, the patient is asked to be positioned on an examination table. A clear gel is applied to the patient’s body in the area to be examined to help the transducer make secure contact with the skin. The sound waves produced by the transducer cannot penetrate air so the gel helps eliminate air pockets between the transducer and the skin. The technologist or radiologist presses the transducer firmly against the skin and sweeps it back and forth to image the area of interest.

▲ 3.5 Liver Biopsy

A liver biopsy is a procedure whereby small pieces of liver tissue are removed in order to be examined signs of damage or disease of the liver. It is very helpful in the diagnosis of diseases that affect the liver.
The physician decides to do a liver biopsy after tests suggest that the liver does not work properly. For example, a blood test might show that your blood contains higher than normal levels of liver enzymes or too much iron or copper. An x-ray could suggest that the liver is swollen. Looking at liver tissue itself is the best way to determine whether the liver is healthy or what is causing it to be damaged.

How it is done?
Liver biopsy is considered minor surgery, so it is done at the hospital. For the biopsy, you will lie on a hospital bed on your back with your right hand above your head. After marking the outline of your liver and injecting a local anesthetic to numb the area, the physician will make a small incision in your right side near your rib cage, then insert the biopsy needle and retrieve a sample of liver tissue. In some cases, the physician may use an ultrasound image of the liver to help guide the needle to a specific spot.
You will need to hold very still so that the physician does not nick the lung or gallbladder, which are close to the liver. The physician will ask you to hold your breath for 5 to 10 seconds while he or she puts the needle in your liver. You may feel pressure and a dull pain. The entire procedure takes about 20 minutes.
In liver biopsy a physician may take help of the CT scan or Ultrasound scanning to locate right the needle in the liver as there might be the chances of the misplace of the needle.

▲ 3. B Diagnostic Studies For Environmental Pollution

This section describes the method to determine the concentration of collected particulate matter randomly selected sites from mixed Faisalabad environment covering industrial, commercial and residential areas in order to have the air quality standards to diagnose the Environmental Pollution.

▲ 3.6 Sample Collection

Kimoto High Volume air sampler was used for the collection of suspended particulate matter in the atmosphere of randomly selected areas of Faisalabad city. The high volume air sample used to pump large volume of air up to 2000 m³ at a rate of 0.8 m³.min^-1. The filter used in a high volume air sample was glass fiber filter. Which have a collection efficiency of 99% for particles.
Samples were collected for a period of 12 Hrs (720 min) at an average flow rate of 0.8 m³.min^-1. Particulate matter was trapped on each filter. Triplicate samples were collected from each place.

▲ 3.6.1 Sampling Mechanism

Kimoto High Volume air sampler was used for the sampling purpose. A high flow rate (0.8 m³.min^-1) draw the air sample through a covered housing 20*25 cm rectangular glass fiber filters. The covered housing is necessary to protect the filter from precipitation & falling debris. Glass fiber filter was used because of their gradual head loss build up characteristics and non-hygroscopic properties. Contamination or damage to filter was avoided while inserting or removing then from the sampler. On removing from the each sampler it was folded in such a way that surface containing the deposits faced each other. The filter was weighed before and after sampling. (Anil, 1994).

▲ 3.6.2 Determination of Weight of Collected Particulate Matter

The weight of each sample from each selected area was calculated by weighing the filter before sampling and after sampling.
The net weight of particulates was obtain by the formula:

W = W₂ – W₁

W = net weight of particulate matter for each sample
W₁ = weight of filter before sampling
W₂ = weight of filter after sampling

the net weight of particulate matter for each sample (which is obtained by subtracting W₁ to W₂).

▲ 3.6.3 U.S. National Air Quality Standards

Standard 1: 60 – 150
Standard 2: 75 – 260

▲ 4. Results and Discussion

▲ 4.1 Data Analysis in Tabular Form

Table 2KC 4.1   Quality of Pollution in Faisalabad

Sr. #	Amount of Pollutants (μg/m³)	Areas
1	350	Residential cum Industrial
2	425	Residential cum Industrial
3	275	Residential cum Commercial
4	680	Residential cum Commercial
5	267	Residential cum Commercial
6	283	Residential cum Commercial
7	390	Residential
8	250	Safe Zone

Table 2KC 4.2   No. of Hepatitis Patients in Hospital 1

Sr. #	Month	No. of effected patients
		Hep B	Hep C
1.	October 2004	2	6
2.	November 2004	3	12
3.	December 2004	1	14
4.	January 2005	1	8
5.	February 2005	1	17
6.	March 2005	4	17
Total	Months 6	12	74

Table 2KC 4.3   Statistical Analysis

x	x‾	(x - x‾)	(x – x‾)²
12	2	10	100
74	12.34	61.66	3801.96

Standard Deviation = S.D = N / √n = (74 – 12) / √6 = 25.32
Mean Standard Deviation = σ_m = σ / √n = 25.32 / 2.45 = 10.34
Co-efficient of Variance = C.V = (σ / x‾) * 100 = (25.32 / 7.17) * 100 = 353.14
Probable Error = 0.67√n = 0.67 * 2.45 = 1.64
Relative Probable Error = .067 / √n = 0.67 / 2.45 = 0.274

Table 2KC 4.4   No. of Hepatitis Patients in Hospital 2

Sr. #	Month	No. of effected patients
		Hep B	Hep C
1.	October 2004	1	11
2.	November 2004	6	12
3.	December 2004	1	18
4.	January 2005	3	12
5.	February 2005	5	14
6.	March 2005	6	16
Total	Months 6	22	83

Table 2KC 4.5   Statistical Analysis

x	x‾	(x - x‾)	(x – x‾)²
22	3.67	18.33	335.99
83	13.84	69.16	4783.11

Standard Deviation = S.D = σ = N / √n = (83 – 22) / √6 = 24.90
Mean Standard Deviation = σ_m = σ / √n = 24.90 / 2.45 = 10.17
Co-efficient of Variance = C.V = (σ / x‾) * 100 = (24.90 / 8.76) * 100 = 284.25
Probable Error = 0.67√n = 0.67 * 2.45 = 1.64
Relative Probable Error = .067 / √n = 0.67 / 2.45 = 0.274

Table 2KC 4.6   No. of Hepatitis Patients in Polluted Areas

Sr. #	Area	Total Respondent	No. of effected patients
			Hep B	Hep C
1.	Industrial	49	19	48
2.	Industrial cum Commercial	17	8	17
3.	Commercial	9	3	8
4.	Commercial cum Residential	7	2	6
Total	Areas 4	82	32	79

Table 2KC 4.7   Statistical Analysis

x	x‾	(x - x‾)	(x – x‾)²
32	8	24	576
79	19.75	59.25	3510.56

Standard Deviation = S.D = σ = N / √n = (79 – 32) / √4 = 23.50
Mean Standard Deviation = σ_m = σ / √n = 23.50 / 2 = 11.75
Co-efficient of Variance = C.V = (σ / x‾) * 100 = (23.50 / 13.88) * 100 = 169.31
Probable Error = 0.67√n = 0.67 * 2 = 1.34
Relative Probable Error = .067 / √n = 0.67 / 2 = 0.335

Table 2KC 4.8   No. of Carcinomas (cancer) patients in Allied Hospital During the Year 2004

Year	Carcinomas Related to Lungs	Carcinomas Related to Other Body Organs
2004	30	67

Table 2KC 4.9   Statistical Analysis

x	x‾	(x - x‾)	(x – x‾)²
30	15	15	225
67	33.5	33.5	1122.25

Standard Deviation = S.D = σ = N / √n = (67 – 30) / √2 = 26.16
Mean Standard Deviation = σ_m = σ / √n = 26.16 / √2 = 18.50
Co-efficient of Variance = C.V = (σ / x‾) * 100 = (26.16 / 24.25) * 100 = 107.87
Probable Error = 0.67√n = 0.67 * √2 = 0.94
Relative Probable Error = .067 / √n = 0.67 / √2 = 0.473

Table 2KC 4.10   Statistical Results of Hepatitis Patients in Hospitals 1 & 2

Sr. #	Std. Deviation σ	Mean Std. Deviation σm	Co-efficient of Invariance C.V	Probable Error P.E	Relative Probable Error R.P.E
Hospital 1	25.32	10.34	353.14	1.64	0.274
Hospital 2	24.90	10.17	284.25	1.64	0.274
Mean	25.11	10.25	318.69	1.64	0.274

Table 2KC 4.11   Statistical Results of Hepatitis Patients in Polluted Areas

Sr. #	Std. Deviation σ	Mean Std. Deviation σm	Co-efficient of Invariance C.V	Probable Error P.E	Relative Probable Error R.P.E
Polluted Area	23.50	11.75	169.31	1.340	0.335

Table 2KC 4.12   Statistical Results of Carcinomas Patients in Allied Hospital during Year 2004

Sr. #	Std. Deviation σ	Mean Std. Deviation σm	Co-efficient of Invariance C.V	Probable Error P.E	Relative Probable Error R.P.E
Allied Hospital	26.16	18.50	107.87	0.94	0.473

▲ 4.2 Graphical Representation

• Pollution Quality Standards in Faisalabad
• No. of Hep B Patients in Hospital 1
• No. of Hep C Patients in Hospital 1
• No. of Hep B Patients in Hospital 2
• No. of Hep C Patients in Hospital 2
• No. of Hep B & C Patients in Hospital 1
• No. of Hep B & C Patients in Hospital 2
• No. of Hep B Patients in Polluted Areas
• No. of Hep C Patients in Polluted Areas
• No. of Hep B & C Patients in Polluted Areas
• Carcinomas Patients in Allied Hospital during 2004

▲ 4.3 Discussion

From our experimental findings, it is concluded that the concentration of ~90% samples was above International Standards, which confirms that Faisalabad Environment is highly polluted, and it may have adverse effects on human health.

Sites were selected using Syntax map method and SRS technique. A comprehensive questionnaire was designed for the sociological survey to obtain valid data. All copies of the questionnaire were distributed among the respondents by hand and collect personally. The respondents were asked to tick on “Yes” or “No” according to their choice of facts. The collected data was analyzed and presented in the tabular form.

Confirmation of diseases is completed through specific tests done at specially selected hospitals in Faisalabad. Those are:

1. M.M. Trust Hospital
2. Allied Hospital

Positive co-relationship between sociological data and experimental findings confirm our plan of study that Faisalabad environment is highly polluted and has adverse effects on human health, so it is strongly recommended that in these stations, the pollution quality management program may be initiated as early as possible meet the future demands. It is hoped that this data may helpful in developing future strategies and for comparison purposes with the other similar locations of the Industrial cum Commercial areas.

▲ 4.4 Conclusions

• Most of the respondents confirm that environmental pollution cause Hepatitis in human beings.
• People living in industrial areas, which are highly polluted areas, are at greater risk to catch the disease.
• Workers, who are working in those industries, are at the greatest risk to catch Hepatitis. Even most of them are suffering from the specific disease.
• Commercial areas and industrial cum commercial areas are also found to be having the disease.
• Even the areas, which are considered to be the safe areas but situated near, polluted areas like industrial and commercial areas are also adversely affected.
• Majority of the respondents confirm that even not experiencing any blood transfusion process (the main cause of Hepatitis B), they are infected with the disease.
• Also a small number of the respondents deny experiencing any cause of Hepatitis B or C (including blood transfusion, body piercing, tattooing, sharing personal items (towels, razors, tooth brushes, earrings) and even not married that is mutual sexual relationship is not occur), they are positive to Hepatitis B or C.

From this study it is also obvious that without the original causes of Hepatitis there are certain other factors involved in generating these diseases, which is the clear indication that environmental pollution may be the main cause of this disease.

▲ 4.5 Recommendations

• Industries should be avoided to establish near in or near the residential areas. Government should start special programs to make sure the establishment of industries in specific industrial areas, which are far away from residential areas.
• Workers, who work in the industries or factories, should not be allowed to work without protecting cloths like gloves, appern and masks etc.
• Workers should be given proper training so as to make them aware of health hazards of mismanagement or carelessness, not only for personal health but also for general public.
• At Government level, special programs should be started to aware the people living in or near those polluted areas about the health hazards of the pollution.
• Industrial hazardous waste management should be given proper guideline for the collection, transportation and disposal of industrial hazardous waste.
• Hepatitis testing to evaluate the risk of HCV/HBV infection in correctional settings is strongly encouraged.
• Mass media can play a vital role in order to create awareness among public about the problems of air pollution due to suspended particles.
• Social workers, Local Government and leaders should be involved to seek public participation in the seminars, symposiums, conferences and workshops both in urban and rural areas.
• Open spaces and greenery road pathways must be provided to the general public.
• Municipal Corporation should make proper management for the removal of garbage and filth from the study.

▲ 5. Summary

The plan of the study under investigation was ”Environmental Pollution on Human Health in respect of Hepatitis-A case study”. The major objectives of the research report were to trace the causes of Hepatitis related to environmental pollution and find co-relationship between Hepatitis with Environmental pollution.

To achieve our goals, data of Hepatitis patients was collected is specially selected hospitals and analyzed for the determination of the environmental pollution.

To confirm these experimental findings, a survey was conducted at mixed environmental areas of Faisalabd, which are selected using Syntax map method and SRS technique. A comprehensive Questionnaire was designed with the help of supervisor for sociological survey to obtain valid data. 100 people were selected for the survey purpose from these areas. The Questionnaire was distributed among the respondents and collected back personally after a prescribed limit of time. The collected data was tabulated, analyzed and interpreted.

Most of the respondents confirmed that there are some factors of environmental pollution involved could cause Hepatitis in human beings. A small number of respondents denied experiencing any cause of Hepatitis but they were positive to the disease.

Positive co-relationship was found between sociological and experimental findings confirm our plan of study that “environmental pollution has adverse effects on human health in respect of Hepatitis”.

It was strongly recommended that in polluted areas the pollution quality management program might be initiated as early as possible to meet the future demands.
It was also recommended that control on Environmental Pollution might help in reduction of the intensity of the Hepatitis.

▲ References

Books:

Research Reports:

Websites:

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